Bioterrorism

Self-Study Examination

Instructions: After studying the text answer the following true/false or multiple choice questions.  Remember, there's only one answer to each question.

1. Which of the following situations would be more manageable by civilian authorities in the event of a terrorist attack?

a) terrorist attack that employs biological weapons
b) a chemical release or a major explosion

2. Terrorism with biological weapons is likely to remain rare.

a) True
b) False

3. Epidemiology investigation indicates an epidemic curve that is compressed (as opposed to steep.) This would indicate

a) a naturally occurring outbreak.
b) an intentional bioterrorism attack.

4. Which of the following forms of anthrax infection causes most fatalities?

a) cutaneous
b) inhalational
c) gastrointestinal

5. Which of the following is not a correct statement about anthrax?

a) Anthrax is not contagious; the illness cannot be transmitted from person to person.
b) There’s no anthrax vaccine available to the general public.
c) At present nasal swab test is the only way to determine if a person has been exposed to anthrax bacteria.

6. Which drug is recommended by the CDC for the treatment and prevention of anthrax?

a) ciprofloxacin
b) doxycycline

7. What is the usual prescribed length of time for which antibiotics should be taken for inhalational anthrax?

a) one week
b) 30 days
c) 60 days
d) until the symptoms disappear

8. Does a patient have immunity after recovering from anthrax infection?

a) yes
b) no
c) not certain, but it is possible

9. A person who has a runny nose along with other common influenza-like symptoms is by far more likely to have the common cold than to have anthrax.

a) True
b) False

10. As per CDC guidelines, in a mail-handling work site, dry sweeping and dusting should be avoided. This is an example of

a) engineering controls.
b) administrative controls.
c) housekeeping controls.

11. If a health-care provider notices certain illness patterns and diagnostic clues associated with intentional release of a biological agent, who should be contacted first?

a) CDC
b) FBI
c) local police
d) local health department

12. What is the most common naturally occurring form of anthrax?

a) inhalational
b) cutaneous
c) gastrointestinal

13. Health-care workers treating hospitalized patients of aerosolized form of anthrax attack should wear air filter masks.

a) True
b) False

14. The greatest risk to human health following an intentional aerosolization of anthrax spores occurs during the period in which anthrax spores remain airborne, called primary aerosolization. What is the maximum time before the aerosol would be fully dispers

a) 4 hours
b) 1 day
c) 7 days
d) 45 days

15. All of the following statements about smallpox are True except

a) Smallpox has now been eradicated from the world.
b) There’s no specific treatment for the disease.
c) Fatality rate for smallpox is over 90%.
d) Direct and fairly prolonged face-to-face contact is required to spread smallpox from one person to another.

16. During which phase smallpox is most contagious?

a) incubation period
b) prodrome phase
c) early rash
d) scab stage

17. Smallpox vaccine is available to the public through major hospitals and public health facilities.

a) True
b) False

18. Which of the following is not a Category A agent for its bioterrorism threat?

a) anthrax
b) plague
c) smallpox
d) SARS

19. The U.S. government has sufficient stockpile of smallpox vaccine to immunize the American public in the event of smallpox outbreak.

a) True
b) False

20. Vaccination after exposure to smallpox is usually ineffective.

a) True
b) False

21. In a small number of cases smallpox vaccine has been known to cause and spread smallpox.

a) True
b) False

22. The list of people who should not get smallpox vaccine includes:

a) pregnant women
b) HIV positive persons
c) children younger than 12 months
d) people with heart conditions
e) all of the above

23. The presence of an adolescent or child (including an infant) in the household is a contraindication to vaccination of other members of the household.

a) True
b) False

24. How long is the immunity provided by smallpox vaccination?

a) 3 to 5 years
b) 20 years
c) lifetime

25. Which of the following is not a True statement about botulism?

a) Botulism is caused by a virus.
b) Botulism is not spread from one person to another.
c) Most botulism patients eventually recover after weeks to months of supportive care.

26. Of the three kinds of botulism, which one is most common?

a) foodborne botulism
b) infant botulism
c) wound botulism

27. What’s the most common source of food botulism?

a) restaurant food
b) home-canned foods
c) honey
d) sausage
e) commercially canned foods

28. What is the most common vehicle for the botulism toxin in the United States?

a) beef
b) milk products
c) poultry
d) vegetables

29. Botulism often mimics all of the following diseases except

a) myasthenia gravis
b) meningitis
c) stroke
d) Guillain-Barré syndrome
e) mushroom poisoning

30. Which country first developed and used botulinum toxin as a bioweapon?

a) Germany
b) Iraq
c) Japan
d) Soviet Union

31. Botulinum toxin used therapeutically in the treatment of migraine headache, chronic low-back pain, stroke, etc., can be used as a bioterrorist weapon, if fallen in the wrong hands.

a) True
b) False

32. Which of the following is the least likely route of botulinum toxin in a bioterrorist attack?

a) foodborne
b) airborne
c) waterborne

33. What is the mortality rate from foodborne botulism?

a) >90%
b) about 50%
c) about 25%
d) about 6%

34. What is the most effective treatment for botulism?

a) botulinum antitoxin
b) antibiotics
c) activated charcoal

35. The CDC recommends preexposure immunization for the general population as a safeguard against the intentional use of botulinum toxin.

a) True
b) False

36. What is the main reason for mortality from plague in this country?

a) improper diagnosis
b) absent or delayed treatment
c) bacilli have become resistant to antibiotics
d) ineffective antibiotics

37. When did plague first arrive in the United States?

a) 1666
b) 1720
c) 1894
d) 1900

38. In the U.S. plague is generally found in

a) urban areas.
b) rural areas.

39. Which form of plague can be spread from person to person?

a) pneumonic
b) bubonic
c) septicemic

40. What is the incubation period for plague?

a) 24 hours
b) 2-6 days
c) 15 days

41. Identify the flea most responsible for the spread of plague to humans:

a) oriental rat flea (X cheopis)
b) human flea (Pulex irritans)
c) bedbugs (Cimex Lectularius)

42. In modern times (20th century) which country has used plague as a biological warfare agent?

a) North Korea
b) Soviet Union
c) Japan
d) Iraq

43. Plague exists in one of two states in nature, enzootic or epizootic. Which state is responsible for the spread of plague to humans?

a) enzootic
b) epizootic

44. What is the drug of choice in the treatment of plague?

a) gentamicin
b) streptomycin
c) doxycycline
d) tetracycline

45. Killed plague vaccine is effective for preventing or ameliorating ______ plague.

a) bubonic
b) pneumonic

46. Ypestis released in aerosol form in a bioterrorist attack would survive for several days to infect a large populace.

a) True
b) False

47. In a biological warfare act, which plague is most likely to be spread?

a) bubonic
b) pneumonic

48. How can one get tularemia?

a) bite of an infected tick or deerfly
b) handling infected animal carcasses
c) eating or drinking contaminated food or water
d) breathing in the disease-causing bacteria
e) all of the above

49. Does tularemia occur naturally in the United States?

a) yes
b) no

50. Select the correct statement about tularemia from below:

a) Tularemia can be spread from person to person.
b) The FDA has approved a vaccination for tularemia.
c) Most cases of tularemia in the United States occur in the southcentral and western states.
d) As a biological weapon, tularemia would be spread through contaminated water.

51. Which of the following is a correct statement?

a) U.S. military at one time maintained a stockpile of F tularensis as a biological weapon.
b) The United States over 30 years ago destroyed its entire biological arsenal.
c) both of the above
d) none of the above

52. Most cases of naturally occurring tularemia are found in _________ areas.

a) urban
b) rural

53. In the event of a biological weapons attack, which of the following is expected to have the lowest case-fatality rate?

a) tularemia
b) plague
c) anthrax

54. Which of the following epidemiologic factors would suggest an intentional act of inhalational tularemia?

a) abrupt onset of large numbers of acutely ill persons
b) rapid progression from upper respiratory symptoms and bronchitis to life-threatening pleur pneumonitis
c) systemic infection among previously healthy adults
d) urban setting
e) all of the above

55. Which is the drug of choice in treating tularemia in a contained casualty setting?

a) streptomycin
b) tetracycline
c) fluoroquinolone
d) ciprofloxacin

56. In a mass casualty situation what is the preferred drug of choice for treating tularemia?

a) streptomycin
b) gentamicin
c) doxycycline

57. What would be the recommended drug for treating pregnant women of tularemia in a mass casualty situation?

a) gentamicin
b) streptomycin
c) ciprofloxacin (oral)

58. Due to potential risk to fetuses, pregnant women with tularemia should not be treated with any drugs.

a) True
b) False

59. Viral hemorrhagic fevers affect

a) lungs.
b) liver.
c) kidney.
d) nervous system.
e) multiple organ systems.

60. For the most part there’s no vaccine available that can protect against viral hemorrhagic fevers.

a) True
b) False

61. When is the risk for person-to-person transmission of hemorrhagic fever viruses the highest?

a) during the incubation period
b) during the latter stages of illness

62. Which of the following hemorrhagic fever viruses do not pose serious risk as biological weapons?

a) ebola
b) Rift Valley fever
c) dengue
d) yellow fever

63. Ricin poisoning cannot be spread from person to person through casual contact.

a) True
b) False

64. Ricin is made from

a) rice
b) castor beans.
c) synthetic chemicals.
d) inorganic waste.

65. At present there’s no antidote for ricin poisoning.

a) True
b) False

66. Which route of exposure to nerve agents is likely to have the slowest onset of toxic effects?

a) inhalational
b) ingestion
c) dermal

67. What is the most useful test to determine if a person has been exposed to nerve agents?

a) x-ray
b) urine test
c) CAT scan
d) blood test

68. During World War II, Germany became the first country to use GA and GB as chemical weapons.

a) True
b) False

69. The United States maintains a stockpile of nerve agents.

a) True
b) False

70. In managing triage for nerve agent mass casualty situation, which of the following categories of victims may have to be given the least resources and attention?

a) immediate
b) delayed
c) minimal
d) expectant

71. When was the first time sulfur mustards were used as chemical warfare agents?

a) Crimean war
b) World War I
c) World War II
d) Iran-Iraq war

72. What is the mortality rate from exposure to sulfur mustard?

a) 2-3%
b) 30%
c) 65%
d) over 90%

73. Decontamination within ______ following exposure to mustard agent is the only effective means for decreasing tissue damage.

a) 1 or 2 minutes
b) 1 hour
c) 4 hours
d) 24 hours

74. Which of the following is a virus, and not a bacterial pathogen?

a) Campylobacter
b) Salmonella
c) E. coli 0157:H7
d) Norwalk

75. Which is a preferred method of investigating a foodborne disease outbreak?

a) laboratory testing of food
b) epidemiological investigation

76. High salt, high sugar or high acid levels cause bacteria to multiply.

a) True
b) False

77. Generally speaking, bacterial microbes need warm moist conditions to multiply to a large number.

a) True
b) False

78. Which of the following foods is most likely to be contaminated?

a) fruits
b) vegetables
c) pasteurized milk
d) raw shellfish

79. Identify the government agency responsible to monitor, investigate, control and prevent public health problems:

a) CDC
b) FDA
c) USDA
d) FBI

80. When was Escherichia coli O157:H7 first recognized as a cause of illness?

a) 1882
b) 1914
c) 1949
d) 1982

81. E. coli cannot be passed from one person to another.

a) True
b) False

82. How is the illness caused by E. coli treated?

a) antibiotics
b) antidiarrheal agents, such as loperamide (Imodium)
c) no specific treatment

83. Which of the following statements about Salmonella is not True?

a) Salmonella is named after the scientist name Salmon who discovered the bacteria.
b) Most people infected with Salmonella recover without any treatment.
c) The best way to prevent Salmonella is through vaccination.
d) Children are the most likely to get salmonellosis.

84. In the United States, the risk for cholera is virtually nonexistent.

a) True
b) False

85. What is the preferred treatment for cholera?

a) antibiotics
b) rehydration

86. Cholera vaccination is required while visiting parts of South America, the Indian subcontinent and sub-Sahara Africa.

a) True
b) False

87. Select the incorrect statement from below:

a) Shigella is named after a Japanese scientist Shiga who discovered it over 100 years ago.
b) Some Shigella bacteria have become resistant to antibiotics making these drugs ineffective.
c) Best treatment for Shigella is antidiarrheal agents such as Imodium or Lomotil.
d) There is no vaccine to prevent shigellosis.

88. What is the most common way to become infected with brucellosis?

a) eating or drinking something that is contaminated with Brucella
b) breathing in the organism
c) having the bacteria enter through skin wounds

89. Who are the carriers of typhoid-causing bacteria, Salmonella Typhi?

a) humans
b) animals
c) shellfish
d) all of the above

90. Which agency would be the chief public health entity to respond to a radiological incident?

a) Food and Drug Administration (FDA)
b) Environmental Protection Agency (EPA)
c) Federal Emergency Management Agency (FEMA)
d) Centers for Disease Control (CDC)
e) local health department

91. About half of those with posttraumatic stress disorder recover within three months without treatment.

a) True
b) False

92. Identify the worst burn:

a) first-degree
b) second-degree
c) third-degree

93. One of the early treatments for any burn is application of butter or ointments to the burn area.

a) True
b) False

94. Glasgow Coma Scale (GCS) is one of the tools used to diagnose:

a) posttraumatic stress disorder
b) complications of third-degree burns
c) mild traumatic brain injury
d) coma induced by drug overdose

95. In which of the following cases the potential for secondary contamination is much higher?

a) victims exposed only to gas or vapor
b) victims whose skin or clothing is soaked with liquid chemical

96. Most chemical agents can penetrate clothing and are absorbed rapidly through the skin.

a) True
b) False

97. The best room to use for shelter during a chemical accident or attack is a room with many windows and doors that can be used as possible escape routes.

a) True
b) False

98. For chemical incidents, the room to be used as shelter should be as ______ as possible.

a) high
b) low

99. Due to heightened concerns about biochemical attacks, people should, as a matter of course, disinfect the drinking water.

a) True
b) False

100. Agents of bioterrorism are generally not transmitted from person to person.

a) True
b) False